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Improving prostate cancer therapy and treatment guidelines

In the UK 11, 714 men die from prostate cancer (PC) annually. The Open University’s Dr Francesco Crea and his team have shown that prolonged exposure to the hormonal therapies used to treat PC can cause the tumour to develop into neuroendocrine prostate cancer (NEPC), a very rare unrelated tumour. In response, Dr Crea and his team in the School of Life, Health and Chemical Sciences produced revised clinical guidelines with new recommendations for NEPC diagnosis and treatment.

Their research and guidelines have improved the quality of life for patients and their families and reshaped clinicians’ and patients’ understanding of how PC progresses and how the therapy can be altered.

Key impacts include:

  • Reduction of the patient’s tumour and improved quality of life
  • Improved patient management and clinical outcomes
  • Potential for considerable cost reduction to the NHS
  • A change in attitudes and understanding of how PC progresses and how the therapy can be altered
  • Influenced changes to a biotech company’s business model

What this research has done

Prostate cancer is the second most common cause of cancer death in males in the UK. According to Cancer Research UK statistics, 11,714 men died from prostate cancer between 2015 and 2017 in the UK.

Hormone therapy is part of the standard care for prostate cancer. It is designed to kill localized or locally advanced prostate cancer. Research undertaken at The Open University, however, showed that when patients are exposed to prolonged hormonal therapies, tumours develop into neuroendocrine prostate cancer (NEPC), a very rare unrelated tumour.

This finding suggests firstly that the use of current hormonal therapies in PC patients must be carefully controlled and monitored and secondly that NEPC incidents are substantially increased by the widespread use of hormonal therapies when treating PC patients.

In the light of this evidence, an international team of clinicians and scientists led by The Open University produced revised clinical guidelines with new recommendations for NEPC diagnosis and treatment. Dr Pandha, Director of the Surrey Cancer Centre confirms that the implementation of these new guidelines with a small group of NECP patients has already resulted in a reduction of unnecessary side effects of hormone therapy (eg fatigue, hot flashes, headaches and high blood pressure) improving NECP patients’ quality of life.

Similar improvements have been reported at the University of Montevideo Hospital, Uruguay and University of KwaZulu-Natal Hospital, South Africa, where the guidelines were also adopted.

The findings also suggest that the NHS could be making a cost-saving of £23,200 per patient through the discontinuation of unnecessary treatment. The Open University’s research modelling results indicated that currently the NHS is spending £96.67 per person/per day on unnecessary treatment over an average period of eight months.

Dr Crea and his team are collaborating with Volition, a company which focussed on developing diagnostic assays for early cancer detection. The company had never considered employing their assays in the context of advanced cancers, and particularly on NEPC. Through collaboration with The Open University and Dr Crea and his team, Volition is now expanding their business model to include the detection of aggressive cancers, including NEPC. Dr Crea’s team is testing these new diagnostic kits before they are clinically tested. It is als working to expand this paridgm to liver cancer, which is highly prevalent in low and middle-income countries.

Research publications

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